High viral suppression rates among PLHIV on dolutegravir who had an initial episode of viral non-suppression in Uganda September 2020-July 2021.

Autor: Namayanja GA; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Da Silva JF; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America., Elur B; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Nasirumbi PM; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Raizes E; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America., Ssempiira J; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Nazziwa E; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Nabukenya M; Central Public Health Laboratories, Ministry of Health, Kampala, Uganda., Sewanyana I; Central Public Health Laboratories, Ministry of Health, Kampala, Uganda., Balaba J; Monitoring and Evaluation Technical Support, Makerere University School of Public Health, Kampala, Uganda., Ntale J; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Calnan J; Office of Health and HIV, United States Agency for International Development, Kampala, Uganda., Birabwa E; Walter Reed Army Institute of Research, US Mission, Kampala, Uganda., Akao J; United States Department of Defense, US Mission, Kampala, Uganda., Mwangi C; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Naluguza M; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Ahimbisibwe A; AIDS Control Program, Ministry of Health, Kampala, Uganda., Katureebe C; AIDS Control Program, Ministry of Health, Kampala, Uganda., Nabadda S; Central Public Health Laboratories, Ministry of Health, Kampala, Uganda., Nelson L; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda., Dirlikov E; Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Jun 26; Vol. 19 (6), pp. e0305129. Date of Electronic Publication: 2024 Jun 26 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0305129
Abstrakt: Background: In 2019, WHO recommended dolutegravir (DTG) as a backbone for first- and second-line antiretroviral therapy (ART) regimens for people living with HIV (PLHIV). According to the 2018 Uganda's HIV treatment guidelines, patients with viral non-suppression (≥1,000 copies/mL) should receive intensive adherence counseling (IAC) with repeat viral load (VL) within 6 months. This analysis focused on the prevalence and factors associated with viral suppression following IAC among PLHIV on DTG-based regimens (DBRs) with an initial episode of viral non-suppression (VNS) in Uganda.
Methods: We conducted a retrospective analysis for PLHIV on DBRs with an initial episode of VNS (≥1,000 copies/mL) in Uganda during October 2019-September 2020 who had a follow up VL test result during September 2020-July 2021. Data were abstracted from the Central Public Health Laboratory (CPHL) database, including patient demographics and VL results. Viral non-suppression (VNS) was defined as a VL test result of ≥1,000 copies/mL. We characterized PLHIV on DBRs and used logistic regression models to determine factors associated with VL suppression after an initial episode of VNS.
Results: A total of 564 PLHIV on DBRs with an initial episode of VNS were followed up and 43 were excluded due to missing data. Of the 521, 220 (42.2%) were children (<15 years) and 231 (44.3%) were female. Median age was 28 years (interquartile range [IQR]: 12-43 years), and median duration on DBRs was 12 months (IQR: 6-15 months). Overall, 80.8% (421/521) PLHIV had a suppressed viral load at first follow up testing (children = 74.5% [164/220]; adults = 85.4% [257/301]). Children with initial VL results ≥5,000 copies/mL were less likely to achieve viral suppression at follow up testing compared to those with <5,000 copies/mL (AOR: 0.38; 95% CI: 0.20-0.71; p = 0.002).
Conclusions: In a programmatic setting, most adults and children suppressed following an initial episode of VNS on DBRs. High rates of suppression after VNS suggest adherence challenges, rather than drug resistance. Continuation of DBRs should be considered before regimen switch.
Competing Interests: The authors have declared no competing interest exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze: MEDLINE
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